应用盆底超声检查探讨肛提肌损伤与盆腔器官脱垂顶端支持结构的相关性  

The correlation between levator ANI injury and the top supported structure of pelvic oragan prolapse by pelvic floor ultrasound

作　　者：李炜 谈诚[1] 唐军[1] 孙秀丽[1] 耿京[1] LI Wei;TAN Cheng;TANG Jun;SUN Xiuli;GENG Jing(Department of Obstetrics and Gynecology,Peking University People's Hospital.Beijing100044,China)

机构地区：[1]北京大学人民医院妇产科,100044 [2]北京医院妇产科,国家老年医学中心

出　　处：《中国妇产科临床杂志》2021年第5期474-476,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家重点研发计划(2018YFC2002204)。

摘　　要：目的应用盆底超声检查探讨盆腔器官脱垂(pelvic organ prolapse, POP)患者肛提肌损伤与盆底顶端支持的相关性。方法回顾性纳入2014年5月至2018年12月于北京大学人民医院妇科术前通过POP定量分期系统(pelvic organ prolapse quantitation, POP-Q)Ⅲ~Ⅳ期的POP患者767例,所有患者均行盆底超声检查,评估肛提肌损伤情况及测量肛提肌裂孔面积。根据超声表现是否存在肛提肌损伤分为两组进行相关因素分析,并对肛提肌损伤组进行多因素分析。结果超声发现肛提肌损伤415例(54.1%),无损伤352例(45.9%)。损伤组D点位置均值(-1.11±2.94)cm,无损伤组均值(-1.85±2.48)cm,差异有统计学意义(P <0.05)。多因素回归分析显示,D点位置下移和裂孔面积增大是肛提肌损伤比例增加的独立危险因素,差异有统计学意义(P <0.05)。线性回归分析发现D点位置下移与肛提肌损伤比例增加存在高度正相关(R=0.856),拟合度较好(R2=0.733)。结论肛提肌损伤与POP顶端支持有显著相关性。盆底超声能为临床提供可靠的评价POP的影像学辅助检查手段。Objective To investigate the correlation between levator ani injury and pelvic floor apical support in the patients with POP by pelvic floor ultrasound. Methods This is a retrospective study of 767 patients with POP–Q staged in Ⅲ ~ Ⅳ. We reviewed the medical records in the gynecology department of Peking University People’s hospital, between May 2014 and December 2018. Pelvic floor ultrasound were performed to evaluate the injury of levator ani and the area of the levator hiatus. Patients were classified into two groups based on whether the levator ani injuryed. The correlation factor between groups were performed and the levator ani injury group was multivariate analyzed. Results 415 patients(54.1%) recruited were with levator ani injury by pelvic floor ultrasound and 352 cases(45.9%) were not. The mean value of the point D in the levator ani injury group was(-1.11 ± 2.94) cm and(-1.85 ± 2.48)cm in non-injury group,(P < 0.05). Multivariate regression analysis showed that the point D downward displacement and the increased area of levator hiatus were independent risk factors for the increased proportion of levator ani injury, with significant differences(P < 0.05). By linear regression analysis, there was a highly positive correlation(R = 0.856) between the position shift at point D and the increased ratio of levator ani injury, with a good degree of fitting(R = 0.733). Conclusions There was a significant correlation between levator ani injury and apical support of POP. Pelvic floor ultrasound can provide reliable imaging auxiliary examination means for clinical evaluation of pelvic organ prolapse.

关 键 词：肛提肌损伤 盆底超声 顶端支持 D点位置 盆腔器官脱垂 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.2[医药卫生—诊断学]